Back pain is the single biggest cause of disability in the world with eighty percent of people in Western society getting an episode of back pain in their life.
Eighty percent.
Nearly everyone.
In the developing world, the stats are something like twenty-five to thirty percent. Underreporting aside, how do people in the developing world only get a third of the back pain that we do? Particularly when they don’t have folks wandering around wearing hard hats and yellow vests saying. ‘Don’t lift that!’ and other health and safety hocus-pocus.
What’s causing the back pain?
The reason for the disparity in the incidence of back pain is due to sitting. People sit for a living, sit for an hour either side of work on their commute, then get home, sit to have dinner, sit watching Harry and Megan on Netflix for a couple of hours, sit playing their Xbox before sitting scrolling through Instagram before bed. But, sitting places as much strain through your back as bending forward badly does. Yet people do it for huge lengths of time every day, so it’s no wonder that they get back pain.
In the developing world, people sit less. They work more physically with shorter commutes, keeping themselves mobile and busy and strong, not sitting all day. In my musculoskeletal physiotherapy clinic, the people I see with back pain aren’t the builders and road workers and farmers that you might think, even though they are lifting and carrying all day – things that are supposed to be bad for your back. They are the accountants and teachers and administrators who sit all day.
No chairs..?
And the thing is, employers and industry are starting to get it. If you walked into some posh offices – like Google’s headquarters, maybe. Yes, you’d see a ‘chill-out’ area with bean bags, whale music and a posh coffee machine. But in the offices themselves you won’t find chairs. They’ll all be height-adjustable standing workstations, with anti-fatigue mats or floor surfaces so your feet don’t ache because you’ve been standing all day.
So, companies are slowly realising that sitting isn’t great for your back. And every so often you might see a red-top newspaper screaming a headline like ‘Back pain and sitting are the new sugar and diabetes.’ But these tend to die away when they wrap up the next day’s fish and chips, and nobody really starts a conversation about it.
With this silent epidemic upon us, do we all need to burn our chairs like some sort of Fahrenheit 451 for the office?
Not just yet. Instead, you can look at some simple strategies to reduce your risk of back pain and the stresses and strains associated with sitting.
The solution? Take a break
The first thing is to take mini-breaks. The Health and Safety Executive recommends we take them. They will break up the pattern of sitting. In the same way as, when you squat down or sit awkwardly for a while you can get really uncomfortable in your knees or back. But simply by getting up and moving around, the discomfort goes away. For those people that say they get a stiff back gradually through the day or maybe getting worse through the working week, this in itself might fix the problem.
A mini-break can simply be standing up at your workstation, stretching up to the ceiling, stretching left and right, maybe wiggling your hips. Nothing really technical at all and maybe only taking twenty to thirty seconds to do. Then you sit back down to carry on working.
That’s it. Simple as that.
The point is you need to do them regularly. Over the years my patients tell me that their backs start to get stiff after about twenty to thirty minutes of sitting. My recommendation, therefore, is that people take a mini-break every twenty minutes. Set an alarm on your computer or phone so you don’t forget. That sounds like taking them might be quite invasive for your working day, but it shouldn’t be. You can do them when you answer the phone, or whenever you proofread an email.
They will become part of the ‘rhythm’ of the day. Certainly, if you sit there for hours staring at your computer screen before taking a break, you will run into the kind of issues we mentioned earlier.
Your Chair
If you get some back pain with sitting in work, some people think they need a more ‘specialist’ chair. But as you can sit nicely in a poor chair and sit badly in a good chair. So saying you need an expensive ‘specialist’ chair is like saying you can smoke a healthy cigarette. For the vast majority of people, a standard office chair is fine to use. It just needs to be adjustable for height and tilt and these functions aren’t broken in any way.
Posture (at work)
How you sit in your chair is also important. Slouching increases the load through your back. Sitting in a good posture, however, will reduce the load of sitting as much as it can. If you work in an office, you probably have some health and safety guidelines on how to sit, the height of the monitor and how far away it should be, and I would recommend you look back at these.
Broadly speaking you should sit so the top of your monitor is level with the top of your head. Meaning you are looking down slightly at the middle of the screen. Your forearms should be horizontal with your elbows at your side. You could call it sitting ‘nicely upright’. Not so bolt upright that you are sitting to attention or ‘sticking your chest out and pulling your shoulders back’ as some people say. That will almost certainly be too much. But by just lifting your chest a little so you feel ‘tall’, your posture will be better. Some colleagues suggest you imagine there is a balloon tied to your head and it is pulling you a little more upright.
This will get you into an optimum position, but as we’ve said before, even sitting in an upright posture places load through your back.
Posture (at home)
Sitting at home. So, you’ve been sitting all day in work. Then you get home, feed the cat and the kids and then pour a glass of wine and settle down to watch some TV, or scroll through your phone. All in sitting. At this point your back is saying, hang on, you’ve been doing this all day and now you aren’t giving me a night off? The strain in your back will be the same whether you are sitting working or chilling out. It might even be worse if your sofa or armchair isn’t very supportive. So, what do you do? Does that mean you can’t relax in an evening?
No, of course not, what you do, is lay down. Instead of sitting on your sofa, you lay down. And instead of sitting next to someone, you throw the back cushions off and lay down next to each other. It might mean moving the room around a bit so you can still see the telly. But it will take all the strain of sitting away, and it will give your back a night off.
Summary
In summary, most people will get back pain at some point in their lives, largely because of the predisposition to use sitting for so many of our daily tasks. To reduce this risk, avoid sitting where you can – such as when relaxing at home, take mini-breaks every twenty minutes when sitting is unavoidable, adjust your chair to give you a chance of sitting nicely and check your posture regularly between your breaks to make sure you are keeping strain to a minimum.
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